Acupuncture: the search for biologic evidence with functional magnetic resonance imaging and positron emission tomography techniques.

399 The subject of acupuncture is surrounded, in some circles, with notions of mysticism and movements of energy through meridian channels invisible to the naked eye and a nomenclature for the internal organs that perplexes many Western-trained scientists confronted with the Chinese literature. While a large number of randomized controlled trials provides growing evidence of the clinical efficacy of acupuncture for treating a variety of medical conditions (National Institutes of Health, 1997; Ernst and White, 1999; Stux and Hammerschlag, 2001) a reliance on apparently unverifiable concepts of energy gives rise to considerable skepticism of this alternative medical modality. Anecdotal reports of patient improvement may be sufficient to persuade the health care consumer but failure to completely demonstrate the relationship of Oriental Medicine to known physiologic systems limits the acceptance of acupuncture in mainstream medicine. Physicians who practice medical acupuncture often provide considerable benefit to patients who have reportedly “failed” to respond to contemporary Western medicine. Thus, these physicians appreciate the enormous clinical value of acupuncture. Nonetheless, historical accounts in Europe and America of such supposedly effective medical cures as “bloodletting” and “mysterious elixirs” led Western physicians to doubt medical procedures not grounded in well-researched, biologic mechanisms and continue to fuel Western cynicism toward Oriental Medicine. However, advances in sophisticated technology utilized in the fields of neuroscience and molecular biology have the potential to lead to greater understanding of the mechanisms underlying the effects of acupuncture. In their paper “A Pilot Study of Functional Magnetic Resonance Imaging of the Brain During Manual and Electroacupuncture Stimulation of Acupuncture Point (LI-4 Hegu) in Normal Subjects Reveals Differential Brain Activation Between Methods” (pages 411–419), Jian Kong et al. demonstrate the complexity of researching even the basic process of needling a major acupuncture point, Large Intestine 4 (LI 4). Nevertheless, their endeavor to explore the centrally mediated effects of acupuncture using functional magnetic resonance (fMRI) brain imaging techniques takes advantage of an opportunity that Chinese doctors from the past